Provider Demographics
NPI:1265914790
Name:LEE, PAMELA PRIBBLE (PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:PRIBBLE
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JAN
Other - Last Name:PRIBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 ROOSTER COGBURN CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-7228
Mailing Address - Country:US
Mailing Address - Phone:817-559-2796
Mailing Address - Fax:
Practice Address - Street 1:124 ROOSTER COGBURN CT
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76088-7228
Practice Address - Country:US
Practice Address - Phone:817-559-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist